Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases

Med J Aust. 2010 Sep 6;193(5):294-6. doi: 10.5694/j.1326-5377.2010.tb03911.x.


Objective: To investigate morbidity related to misuse of over-the-counter (OTC) codeine-ibuprofen analgesics.

Design and setting: Prospective case series collected from Victorian hospital-based addiction medicine specialists between May 2005 and December 2008.

Main outcome measures: Morbidity associated with codeine-ibuprofen misuse.

Results: Twenty-seven patients with serious morbidity were included, mainly with gastrointestinal haemorrhage and opioid dependence. The patients were taking mean daily doses of 435-602 mg of codeine phosphate and 6800-9400 mg ibuprofen. Most patients had no previous history of substance use disorder. The main treatment was opioid substitution treatment with buprenorphine-naloxone or methadone.

Conclusions: Although codeine can be considered a relatively weak opioid analgesic, it is nevertheless addictive, and the significant morbidity and specific patient characteristics associated with overuse of codeine-ibuprofen analgesics support further awareness, investigation and monitoring of OTC codeine-ibuprofen analgesic use.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics / adverse effects*
  • Codeine / adverse effects*
  • Drug Combinations
  • Drug Overdose / epidemiology
  • Female
  • Humans
  • Ibuprofen / adverse effects*
  • Incidence
  • Male
  • Nonprescription Drugs / adverse effects*
  • Substance-Related Disorders / diagnosis*
  • Substance-Related Disorders / epidemiology
  • Victoria / epidemiology
  • Young Adult


  • Analgesics
  • Drug Combinations
  • Nonprescription Drugs
  • Codeine
  • Ibuprofen